Report: In-home services inefficient, ripe for fraud

Document

Residents are paying a high price for in-home services that are inefficient and subject to fraud and abuse, according to a report released by the San Diego County Grand Jury Tuesday.

The laws regarding In-Home Supportive Services are complex, overlap and contain several loopholes that could prevent the county from validating that services are delivered, the report states. The state and federally mandated program provides non-medical care to low-income aged, blind and disabled people to remain in their homes.

County officials are prohibited from making unannounced home visits to check on a participant’s needs and validate the hours on a caregiver’s timecard. The report also found it’s legal for a felon to serve as a caregiver in the program and that only about 20 percent of people receiving services are severely impaired and unable to care for themselves.

Increased enrollment has forced caseworkers to take on large caseloads, overseeing some 300 recipients each, the report states.

About 25,000 people are assisted by 22,000 caregivers in the region. Last year, the county contributed $53 million of a total $305 million to administer the program, with the remainder covered by state and federal funds. The rise in local costs, which have increased 9 percent per year since 2000, are diverting funds from other services and are unsustainable, said grand jury Foreman Richard Carlson.

Carlson said he recognized in-home services could be a viable alternative to nursing homes. He noted that 67 percent of caregivers are known to recipients, including family and friends. The Health and Human Services Agency, which administers the program, has no authority to verify a caregiver worked the assigned hours or that required care was delivered, Carlson said.

“You’re depending on the consumer to make sure that they are getting proper care,” he said. “They may have difficultly making that decision themselves.”

Steve Mehlman, communications director for the statewide UDW Homecare Providers Union, said the legislature passed a law requiring all caregivers to undergo a background check, including fingerprinting.

He also took issue with the characterization that tax dollars could be paid to convicted felons, noting that there was no local data to support that and the report relied on anecdotes. “To say that there are rampant examples of this, or to make that allegation, is totally without facts and inflammatory,” Mehlman said.

Local officials, offering varying degrees of support for the program’s original intent, have spent years wrestling with how to rein in aspects of in-home services.

The grand jury recommended that county supervisors draft regulations in collaboration with state legislators to revise timecard management guidelines and ensure only those that need the program qualify. It also encouraged county health officials to develop internships with local universities that educate future social workers and forge interagency agreements so county sheriffs could access records for criminal investigations.

Supervisor Dianne Jacob, who has long advocated for changes, said she welcomed the grand jury’s findings, adding that they were consistent with previous reports and actions by the county. “Progress has been made at the local level, but the hurdle we still face is securing state legislation that would rein in costs and give greater local control,” she said.

Supervisor Bill Horn, who has argued that the state program is rife for fraud, said he’s called for the local delegation to reform on many occasions.